The ACGME and the American Board of Anesthesiology accredit the Pain Management Fellowship Program at M. D. Anderson Cancer Center.

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1 Pain Management Fellowship Facts The Fellowship Program in Pain Management is a fifth-year level program of one-year duration that prepares a fellow in all aspects of pain management. Each year, four new fellows are selected to begin training in July. Successful completion of fellowship training results in an institutional certification by The University of Texas. In order to be qualified for certification, the fellow must complete 12 months of training within the section, perform in a satisfactory manner, present at least four (4) oral presentations including a Grand Rounds presentation, and prepare an article suitable for publication. The ACGME and the American Board of Anesthesiology accredit the Pain Management Fellowship Program at. The Fellowship Mission The fellowship program has a rich tradition of providing fellows with a comprehensive experience in pain management, including appropriate applications of traditional and innovative pharmacologic therapies and interventional procedures. Our training mission is to inspire and to aid future leaders to advance their current education through developing advanced knowledge and skills in pain management while practicing excellent patient care and participating in a stimulating learning and research environment. Training experiences are substantially integrated with interactive teaching sessions focused toward understanding basic foundations of pain management. Diverse didactic experiences stimulate fellows to go beyond the current methods in pain management. Fellowship Goals and Objectives The primary goal is that over the course of the fellowship program the fellow should become competent and sensitive to a patient s needs to serve as a consultant for problems related to pain management. This includes the management of straightforward and complex pain syndromes in ambulatory and hospitalized patients. Fellows should be able to manage such problems, even when complicated by the presence of other symptoms, complex medical illness and psychological distress. The following goals and objectives (shorter version) address ACGME general competencies and fellowship program competencies. Patient Care & Interpersonal Communication To provide patient care that is honest, compassionate, appropriate, and effective to assess and treat pain To actively participate in an information exchange about pain management in patient care with patients, their families, and other health professionals Medical Knowledge To understand about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and socialbehavioral) sciences and the application of this knowledge to patient care To know and apply the basic and clinically supportive sciences applicable to pain management patient care To reach a consultant level in the expert prescription of a complex pharmacopoeia

2 Practice-Based Learning and Improvement To gain hands-on experience in anesthetic procedures used to treat malignant and nonmalignant pain To acquire a diverse understanding of the principles, philosophy, and knowledge/skills of pain management Professionalism To pursue a commitment to excellence and ongoing professional development Systems-Based Practice To understand the health care organizational structure of other health care professionals and society in general and how these elements affect their practice Duties and Responsibilities of Trainees Attendance is mandatory at all core curriculum lectures, seminars, interdisciplinary conferences, institutional grand rounds, literature reviews, and monthly board review courses, and evaluations must be submitted for each lecture attended. The teaching capabilities of our fellows are enhanced by their mandatory and direct participation as educators and presenters at various educational opportunities. Formal oral presentations are made at lectures upon request from the faculty. Fellows will be allotted funds for rotations out of the Houston area. Within the clinical experience, fellows are challenged to contribute within a busy environment of multidisciplinary pain management where training and staff clinicians from many specialties work together. Our patient population ranges from adults to children, inpatients to outpatients with acute, postoperative, and chronic malignant pain, as well as nonmalignant pain. Fellows are exposed to the full range of pain treatments from medical to interventional, including psychological and rehabilitation techniques. Broad ranges of interventional procedures are performed including neurolytic techniques and implantable devices (e.g., spinal pump infusions and stimulators). Fellows selected will maintain the normal working hours of the Section of Cancer Pain Management (Monday Friday, 7:30 am 5:00 pm). The fellow is expected to remain after normal working hours when making hospital rounds or to finish clinical duties. Additionally, each fellow will be on-call with an assigned faculty member for a week at a time on a rotating basis. The program s extensive clinic and educational duties does not allow for outside work; therefore, no moonlighting is allowed. Private practice of any capacity will not be allowed. and the ACGME require that all fellows enrolled in a one-year fellowship program must complete a research project for publication under a mentoring faculty member before a fellowship certificate is awarded. Each fellow is required by ACGME and ABA Policy to keep a detailed, accurate log of all training activities at MDACC and on external rotations. A monthly report is to be turned in at the end of the month to be kept as part of a fellow s permanent training record. Internal Rotations Every month, each fellow will rotate monthly as follows: Inpatient Rotation The primary goals for the Inpatient Fellow on this rotation are to manage inpatient pain problems and to provide the patient with the appropriate continuity of care needed during hospitalization in addition to developing proper communication skills in discussing a patient s analgesic needs with the primary service. The Inpatient Fellow will also develop interpersonal skills needed to manage and treat complex pain problems throughout the course of the patient s illness. 2

3 The Inpatient Fellow will be responsible for triage duties for consult requests for pain management. For routine postoperative consults, the Inpatient Fellow will assess the patient and perform the initial history and physical examination. An advanced practice nurse or physician s assistant will then follow the patient and discuss the patient s daily progress with the Inpatient Fellow or the staff physician. For other (non-postoperative) consults, the Inpatient Fellow will be responsible for the patient s care on a daily basis, beginning with the history and physical examination on the first day. The Inpatient Fellow will also be required to round on their patients on a daily basis and formulate a thoughtful care plan. After discussion with the staff physician, the Inpatient Fellow will be responsible for the implementation of the plan. Three months (in one-month blocks) are allocated for this rotation. Clinic Rotation Goals for the Clinic Fellow on this rotation are to perform rapid assessment in a clinic setting, to improve presentation skills, proper dictation and record keeping, to establish decision-making skills in treating pain problems, and to learn proper guidelines for prescriptions. The Clinic Fellow will be responsible for daily activities in the clinic. Clinic assignments will rotate between the various staff physicians assigned to that day s clinic. The Clinic Fellow will assess patients, perform a complete history and physical examination, and present the patient to the staff physician. The presentation should also include a carefully formulated plan of treatment. Fellows will develop the skills above during the time spent on this rotation. After the patient is seen by the staff physician and is discharged from the clinic, the Clinic Fellow will be responsible for dictating the record of the patient s visit. Three months (in one-month blocks) are allocated for this rotation. Interventional Rotation The primary goal of this rotation is to aid the Interventional Fellow in developing the confidence to perform interventional pain procedures with guidance from a staff physician. The Interventional Fellow will be responsible for all interventional procedures during the month. This will include performing proper assessment of the patient, obtaining proper consent, obtaining all radiological images prior to performing the procedure, reading about the procedure the day before (if possible), setting up the room and equipment for the procedure, dictating a complete procedure (or operative) note, and follow-up assessment of the patient in the day(s) following the procedure. When there are no procedures scheduled for the day, the Interventional Fellow will be responsible for providing back-up assistance to the Clinic Fellow or Inpatient Fellow. Two months (in one-month blocks) are allocated for this rotation. New requirements implemented by ACGME effective 2007: Acute Pain Anesthesia OR Neurology Palliative Care Physical Medicine and Rehabilitation Psychology 3

4 External Rotation Fellows will learn about pain management not offered at. Specifically, these include rotations in the private practice setting and in predominantly non-malignant pain clinics. External Rotations are designed to provide intensive training in diagnostic and therapeutic treatment related to the management of acute and chronic nonmalignant pain syndromes. Fellows will learn: to follow appropriate care and treatment guidelines to reassess individuals that do not respond to the most common pain therapies to provide a time-governed (e.g., short or long-term) treatment of pain While on external rotations, fellows will not take call. All fellows are required to complete the mandatory staff evaluations for their rotations. A maximum of two (2) months may be taken on external rotations and only one fellow may be gone at a time to allow for adequate coverage. External rotations are available at the following: The Pain Management Clinic (Private Practice Rotation) Stephen Sims, M.D. Huntsville, Texas In the Private Practice Rotation, fellows will be responsible for learning to efficiently perform interventional procedures and to learn about the private practice office-based setting. Fellows are exposed to patients that receive treatments based largely on interventional pain management. Fellows must follow the guidance of Dr. Sims, who is affiliated with our program, and should adhere to his instruction while performing hands-on procedures. Dr. Sims supervises all fellows during patient visits and while doing procedures, and he will also evaluate the performance of the rotating fellow. The Pain Management Center at the University of Texas Medical Branch at Galveston Courtney Williams, M.D., Medical Director Galveston, Texas This rotation is designed to provide intensive training in diagnostic and therapeutic injections related to the management of acute and chronic pain patients. These include, but are not limited to peripheral nerves and muscles, spinal column and sympathetic nerves. Neuromodulation and intrathecal therapy is utilized when needed. Also, fellows will have the opportunity to work closely with pain management psychologists and physical therapists in a multidisciplinary setting to help patients to deal with chronic pain. Fellows will work under the supervision of faculty to see patients and to do procedures. Dr. Williams will evaluate the performance of the rotating fellow. Supervision All fellows will work under the supervision of an attending physician or teaching faculty member so that as fellows progress in training increased responsibility is assumed according to their level, education, ability and experience. Increased levels of responsibilities will be assessed and determined by the Program Director and the Fellowship Committee. Administrative Support is provided through a dedicated Program Coordinator. Evaluation Faculty regularly submits monthly (informal) evaluations on a fellow s progress Fellows complete an evaluation on computer usage during orientation and at the end of the year 4

5 Fellows evaluate faculty semi-annually Faculty and fellows both submit a formal end of the year evaluation A final evaluation letter, written by the Program Director is also kept within each fellow s file Each fellow is also evaluated informally and guided through the development of a research article suitable for publication in a leading pain management journal Fellows also participate in informal ongoing discussion with faculty to assess progress and learning content. Vacation, Sick, and Administrative Leave Fellows begin each academic year (July 1) with 15 days of PTO leave, and early planning of vacation is highly recommended. Given the service requirements of the Inpatient and Clinic Rotations, no leave can be taken while on rotation. No single absence from the section may exceed 5 working days, and at least one week must be taken during the first six months. No annual leave is permitted during July to allow for sufficient orientation to the service and to The. Sick leave is also incorporated into PTO leave. A signed doctor s excuse note must be obtained for all sick leave. In the event of personal illness or illness of one s child, the fellow is responsible for calling the Attending Physician and the Program Coordinator no later than 8:30 a.m. to allow time for scheduling needs. Fellows do not receive payment for unused PTO leave at the end of the training year. Fellows begin each academic year (July 1) with 5 days of administrative leave, two (2) days for interviews and three (3) days to attend major scientific and professional meetings/conferences. Administrative leave may also be used to attend professional seminars or board reviews. Requests for additional administrative leave will be considered on an individual basis when a fellow is invited to present at more than one major scientific meeting/conference, and all administrative leave requests must be submitted prior to taking leave. American Board of Anesthesiology (ABA) Policy Note: No fellow may be absent for more than 20 days total. When a fellow resumes training after a prolonged absence or takes time away from the program in excess of 20 days, the ABA Credentials Committee shall determine the number of months of training fellows must complete after resuming training to satisfy the training requirement for admission to the ABA examination system. Stipend Stipends are awarded based on the National Institute of Health s National Research Service Award stipend for zero years of experience. Annual incremental increases are awarded for PGY levels 1-5. Professional Liability, Permit, and/or Licensure Requirements Fellows who do not have a Texas Medical License are required by the Texas State Board of Medical Examiners to have an institutional permit to serve in the hospital. Student Trainee Resources prior to the beginning of the training period will forward an application for such a permit. Institutional permits will not allow fellows to practice outside of. Medical Liability insurance is provided by M. D. Anderson. Visa Requirements Fellows are required to maintain valid documents indicating evidence of their authorization for employment in the United States and for the purpose of establishing their identity. This applies to both U.S. Citizens and non-u.s. Citizens. 5

6 Benefits Insurance All insurance selections are effective your first day of employment with. Employees may choose from a variety of programs and services, including: Medical Insurance Several medical plans to select from Prescription Drug Plan Dental Insurance (two plans to select from) Vision Coverage (available once a year during annual benefits enrollment) Life and Disability Insurance Group Term Life Personal Accident Long Term Disability * pays a portion of the total premium of selected insurance coverage. Flexible Spending Accounts Employees may use flexible spending accounts to direct a portion of pre-tax salary to pay for unreimbursed Medical and Dependent Care expenses. Retirement Options Teacher Retirement System (TRS): the state retirement plan that provides retirement, disability and death benefits to eligible M. D. Anderson employees. Tax Sheltered Annuities (TSA): we offer voluntary participation in a Tax Sheltered Annuity plan, which allows employees to make tax deferred contributions to supplement their state retirement benefits. Family Care Resource and Referral Employees are provided with referral services for childcare, elder care, college and adoption resources. Employee Assistance Program (EAP) A confidential resource. Free of charge, to help our employees and their families resolve a variety of personal and family stresses: Marital/family, parent/child, relationship issues Personal legal assistance Depression, anxiety and other mental health issues Drug and alcohol abuse Other Services 10% cafeteria discount Employees may join the Communicators Federal Credit Union, which offers banking, savings and loan services. 6

7 Around Houston Houston is the fourth largest city in the United States with all of the cultural and recreational diversity of a major metropolitan area. Houston s multiethnic population gives the city a distinct flavor and sophistication. Large and active ethnic communities offer fine food, shopping, entertainment, and cultural festivals. Houston's museums, theaters, and concert halls nourish an environment rich in the fine arts. Seeing sporting events or even just going to the Houston Zoo are popular activities. Recreational Facilities are widespread throughout the city, with many parks, bicycle paths, jogging trails, and swimming pools. The Gulf of Mexico and the island of Galveston are nearby, as is the NASA/Johnson Space Center. Whatever your interests, Houston offers convenience and proximity to an array of activities and events for weekday and weekend excursions. A great place to begin learning more about Houston is or the Trainee Survival Manual available through Trainee and Alumni Affairs. For more information regarding training opportunities with the Cancer Pain Management Section, please contact Trisha Rendon at or lrendon@mdanderson.org All applications must be submitted electronically in the Discover database system at All supporting letters must be addressed as follows: Basem Hamid, M.D., Assistant Professor, Pain Fellowship Director Unit 409 U. T Holcombe Blvd. Houston, TX